Dynamic association and documentation

ABSTRACT

Methods, systems, and computer-storage media are provided for enabling a user to dynamically create associations and take actions with respect to a clinical finding associated with a patient. After selecting a clinical finding that is of interest in a first workflow application, a graphical user interface is automatically presented. The graphical user interface includes trending information for the clinical finding as well as information related to the clinical finding. The graphical user interface enables a clinician to associate the clinical finding with a current patient problem or a possible diagnosis related to the clinical finding. Additionally, the graphical user interface enables the clinician to take actions with respect to the clinical finding.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application, having attorney docket number CRNI.183018, claims thebenefit of priority to U.S. Provisional Application No. 61/842,125,filed Jul. 2, 2013, and entitled “Dynamic Association and Documentationand Multi-Disciplinary Team Workspace and Clinical Document SpeedViewer.” The entirety of the aforementioned application is incorporatedby reference herein.

This application, having attorney docket number CRNI.183018, is alsorelated by subject matter to U.S. patent application Ser. No. ______,entitled “Multi-Disciplinary Team Workspace” having attorney docketnumber CRNI.183019; and to U.S. patent application Ser. No. ______,entitled “Clinical Document Speed Viewer” having attorney docket numberCRNI.183020, both of which are assigned or under obligation ofassignment to the same entity as this application and both of which areexpressly incorporated by reference herein. All three applications arebeing filed on the same date.

BACKGROUND

Although clinician workflow applications are numerous, they oftenaddress discrete tasks and require a clinician to access multipledifferent applications in order to fully address a clinical finding. Forexample, a clinician may discover that a patient has an abnormalpotassium level when viewing, for example, a list of recent labs in aclinician workflow application. In order for the clinician to addressthe low potassium, the clinician may have to navigate away from theclinician workflow application and open an ordering application toassociate the low potassium with an existing clinical order or to orderpotassium replacement therapy. Additionally, the clinician may have toopen a clinical note application in order to associate the low potassiumwith an existing clinical note or to create a new clinical noteaddressing the low potassium. Having to navigate to multiple differentworkflows in order to fully address a problem results in inefficiencyand increases the chances for error.

Another problem in today's highly-specialized healthcare world is thecoordination of care for patients that have multiple medical problems.Such patients are often cared for by a multi-disciplinary care team madeup of clinicians having different areas of expertise. For example, apatient having both gastro-intestinal problems and cardiovascularproblems may be cared for by clinicians specializing in internalmedicine, cardiology, and gastro-enterology. Coordinating care by thesedifferent specialists is challenging. In most cases, the specialists donot have access to workflows that detail the care given by eachspecialist. The result is again inefficiency, the possibility ofredundant care, and increased chance of error.

Yet another problem faced by clinicians is the monumental task ofsearching through the voluminous quantity of clinical documents oftenassociated with today's patients. An individual patient may havehundreds of clinical documents generated by everyone involved in thepatient's care from dieticians to neurosurgeons. Traditional approachesto searching include presenting clinical documents in reversechronological order and searching through the documents one-by-one.

SUMMARY

This Summary is provided to introduce a selection of concepts in asimplified form that are further described below in the DetailedDescription. This Summary is not intended to identify key features oressential features of the claimed subject matter, nor is it intended tobe used as an aid in determining the scope of the claimed subjectmatter. The present invention is defined by the claims.

In brief and at a high level, this disclosure describes, among otherthings, methods, systems, and computer-storage media for presenting agraphical user interface (GUI) that enables a clinician to fully addressa clinical finding (e.g., place orders, create associations, reviewinformation, create a clinical document, and the like) while workingwithin the context of a workflow application, regardless of the natureof the application. A clinician utilizing a first workflow can select,for example, an abnormal lab value within the workflow application andbe automatically presented with a GUI that enables the clinician toreview trending information for the abnormal lab value as well asadditional lab values and medications that are related to the abnormallab value. Further, the GUI presents a current problem list for thepatient as well as one or more possible diagnoses that are generatedbased on the abnormal lab value. The clinician is able to dynamicallyassociate the abnormal lab value with one or more of the clinicalproblems and/or the possible diagnoses. The GUI may additionally includean action area that enables the clinician to take one or more actions(e.g., order actions, message actions, documentation actions, and thelike) with respect to the abnormal lab value.

BRIEF DESCRIPTION OF THE DRAWINGS

Embodiments are described in detail below with reference to the attacheddrawing figures, wherein:

FIG. 1 is a block diagram of an exemplary computing environment suitableto implement embodiments of the present invention;

FIG. 2 is a block diagram of an exemplary system for generatinggraphical user interfaces useable for dynamically creating associationsand taking actions with respect to an item of clinical information,facilitating care of a patient by a multi-disciplinary care team, andfor searching clinical documents associated with the patient suitable toimplement embodiments of the present invention;

FIG. 3 is an exemplary graphical user interface demonstrating aclinician workflow in accordance with an embodiment of the presentinvention;

FIG. 4 is an exemplary graphical user interface for dynamically creatingassociations and taking actions with respect to an item of clinicalinformation in accordance with an embodiment of the present invention;

FIG. 5 is an exemplary graphical user interface useable for facilitatingpatient care by a multi-disciplinary care team in accordance with anembodiment of the present invention;

FIG. 6 is an exemplary graphical user interface useable for searchingclinical documents associated with a patient in accordance with anembodiment of the present invention; and

FIG. 6A depicts the exemplary graphical user interface of FIG. 6 andincludes a filter selection area useable for selecting one or moreclinical document filters in accordance with an embodiment of thepresent invention.

DETAILED DESCRIPTION

The subject matter of the present invention is described withspecificity herein to meet statutory requirements. However, thedescription itself is not intended to limit the scope of this patent.Rather, the inventors have contemplated that the claimed subject mattermight also be embodied in other ways, to include different steps orcombinations of steps similar to the ones described in this document, inconjunction with other present or future technologies. Moreover,although the terms “step” and/or “block” may be used herein to connotedifferent elements of methods employed, the terms should not beinterpreted as implying any particular order among or between varioussteps herein disclosed unless and except when the order of individualsteps is explicitly described.

Embodiments of the present invention are directed to methods, systems,and computer-storage media for presenting a graphical user interface(GUI) that enables a clinician to fully address a clinical finding(e.g., place orders, create associations, review information, create aclinical document, and the like) while working within the context of aworkflow application, regardless of the nature of the application. Aclinician utilizing a first workflow can select, for example, a clinicalfinding such as an abnormal lab value within the workflow applicationand be automatically presented with a GUI that enables the clinician toreview trending information for the abnormal lab value as well asadditional lab values and medications that are related to the abnormallab value. Further, the GUI presents a current problem list for thepatient as well as one or more possible diagnoses that are generatedbased on the abnormal lab value. The clinician is able to dynamicallyassociate the abnormal lab value with one or more of the clinicalproblems and/or the possible diagnoses. The GUI may additionally includean action area that enables the clinician to take one or more actions(e.g., order actions, message actions, documentation actions, and thelike) with respect to the abnormal lab value.

An exemplary computing environment suitable for use in implementingembodiments of the present invention is described below. FIG. 1 is anexemplary computing environment (e.g., medical-informationcomputing-system environment) with which embodiments of the presentinvention may be implemented. The computing environment is illustratedand designated generally as reference numeral 100. The computingenvironment 100 is merely an example of one suitable computingenvironment and is not intended to suggest any limitation as to thescope of use or functionality of the invention. Neither should thecomputing environment 100 be interpreted as having any dependency orrequirement relating to any single component or combination ofcomponents illustrated therein.

The present invention might be operational with numerous other purposecomputing system environments or configurations. Examples of well-knowncomputing systems, environments, and/or configurations that might besuitable for use with the present invention include personal computers,server computers, hand-held or laptop devices, multiprocessor systems,microprocessor-based systems, set top boxes, programmable consumerelectronics, network PCs, minicomputers, mainframe computers,distributed computing environments that include any of theabove-mentioned systems or devices, and the like.

The present invention might be described in the general context ofcomputer-executable instructions, such as program modules, beingexecuted by a computer. Exemplary program modules comprise routines,programs, objects, components, and data structures that performparticular tasks or implement particular abstract data types. Thepresent invention might be practiced in distributed computingenvironments where tasks are performed by remote processing devices thatare linked through a communications network. In a distributed computingenvironment, program modules might be located in association with localand/or remote computer storage media (e.g., memory storage devices).

With continued reference to FIG. 1, the computing environment 100comprises a computing device in the form of a control server 102.Exemplary components of the control server 102 comprise a processingunit, internal system memory, and a suitable system bus for couplingvarious system components, including data store 104, with the controlserver 102. The system bus might be any of several types of busstructures, including a memory bus or memory controller, a peripheralbus, and a local bus, using any of a variety of bus architectures.Exemplary architectures comprise Industry Standard Architecture (ISA)bus, Micro Channel Architecture (MCA) bus, Enhanced ISA (EISA) bus,Video Electronic Standards Association (VESA) local bus, and PeripheralComponent Interconnect (PCI) bus, also known as Mezzanine bus.

The control server 102 typically includes therein, or has access to, avariety of non-transitory computer-readable media. Computer-readablemedia can be any available media that might be accessed by controlserver 102, and includes volatile and nonvolatile media, as well as,removable and nonremovable media. By way of example, and not limitation,computer-readable media may comprise non-transitory computer storagemedia and communication media. Computer storage media includes bothvolatile and nonvolatile, removable and non-removable media implementedin any method or technology for storage of information such ascomputer-readable instructions, data structures, program modules orother data. Computer storage media includes, but is not limited to, RAM,ROM, EEPROM, flash memory or other memory technology, CD-ROM, digitalversatile disks (DVD) or other optical disk storage, magnetic cassettes,magnetic tape, magnetic disk storage or other magnetic storage devices,or any other medium which can be used to store the desired informationand which can be accessed by control server 102. Communication mediatypically embodies computer-readable instructions, data structures,program modules or other data in a modulated data signal such as acarrier wave or other transport mechanism and includes any informationdelivery media. The term “modulated data signal” means a signal that hasone or more of its characteristics set or changed in such a manner as toencode information in the signal. By way of example, and not limitation,communication media includes wired media such as a wired network ordirect-wired connection, and wireless media such as acoustic, RF,infrared and other wireless media. Combinations of any of the aboveshould also be included within the scope of computer-readable media.

The control server 102 might operate in a computer network 106 usinglogical connections to one or more remote computers 108. Remotecomputers 108 might be located at a variety of locations in a medical orresearch environment, including clinical laboratories (e.g., moleculardiagnostic laboratories), hospitals and other inpatient settings,veterinary environments, ambulatory settings, medical billing andfinancial offices, hospital administration settings, home healthcareenvironments, and clinicians' offices. Clinicians may comprise atreating physician or physicians; specialists such as surgeons,radiologists, cardiologists, and oncologists; emergency medicaltechnicians; physicians' assistants; nurse practitioners; nurses;nurses' aides; pharmacists; dieticians; microbiologists; laboratoryexperts; laboratory technologists; genetic counselors; researchers;veterinarians; students; and the like. The remote computers 108 mightalso be physically located in nontraditional medical care environmentsso that the entire healthcare community might be capable of integrationon the network. The remote computers 108 might be personal computers,servers, routers, network PCs, peer devices, other common network nodes,or the like and might comprise some or all of the elements describedabove in relation to the control server 102. The devices can be personaldigital assistants or other like devices.

Computer networks 106 comprise local area networks (LANs) and/or widearea networks (WANs). Such networking environments are commonplace inoffices, enterprise-wide computer networks, intranets, and the Internet.When utilized in a WAN networking environment, the control server 102might comprise a modem or other means for establishing communicationsover the WAN, such as the Internet. In a networking environment, programmodules or portions thereof might be stored in association with thecontrol server 102, the data store 104, or any of the remote computers108. For example, various application programs may reside on the memoryassociated with any one or more of the remote computers 108. It will beappreciated by those of ordinary skill in the art that the networkconnections shown are exemplary and other means of establishing acommunications link between the computers (e.g., control server 102 andremote computers 108) might be utilized.

In operation, an organization might enter commands and information intothe control server 102 or convey the commands and information to thecontrol server 102 via one or more of the remote computers 108 throughinput devices, such as a keyboard, a pointing device (commonly referredto as a mouse), a trackball, or a touch pad. Other input devicescomprise microphones, satellite dishes, scanners, or the like. Commandsand information might also be sent directly from a remote healthcaredevice to the control server 102. In addition to a monitor, the controlserver 102 and/or remote computers 108 might comprise other peripheraloutput devices, such as speakers and a printer.

Although many other internal components of the control server 102 andthe remote computers 108 are not shown, such components and theirinterconnection are well known. Accordingly, additional detailsconcerning the internal construction of the control server 102 and theremote computers 108 are not further disclosed herein.

Turning now to FIG. 2, an exemplary computing system environment 200 isdepicted suitable for use in implementing embodiments of the presentinvention. The computing system environment 200 is merely an example ofone suitable computing system environment and is not intended to suggestany limitation as to the scope of use or functionality of embodiments ofthe present invention. Neither should the computing system environment200 be interpreted as having any dependency or requirement related toany single module/component or combination of modules/componentsillustrated therein.

The computing system environment 200 includes a number of services suchas a dynamic association and documentation service 210, amulti-disciplinary care team service 212, and a clinical documentservice 214. Each of the services 210, 212, and 214 may be incommunication with one another via a network 220. The network 220 mayinclude, without limitation, one or more local area networks (LANs) orwide area networks (WANs). The network 220 may be a secure networkassociated with a healthcare facility. The secure network 220 mayrequire that a user log in and be authenticated in order to send and/orreceive information over the network 220. Additionally, each of theservices 210, 212, and 214 are in communication with a data store 216and an end-user computing device 218 having a display screen 219.

Although the services 210, 212, and 214 are depicted as separateservices, it is contemplated that the services may be combined into oneservice. Additionally, although each service 210, 212, and 214 isdepicted as having its own components, in reality a component, such as arendering component may be shared by the different services 210, 212,and 214. The services 210, 212, and 214 are depicted separately tofacilitate ease of explanation for each of the services 210, 212, and214.

In some embodiments, one or more of the illustrated components/modulesmay be implemented as stand-along applications. In other embodiments,one or more of the illustrated components/modules may be integrateddirectly into the operating system of the services 210, 212, and 214.The components/modules illustrated in FIG. 2 are exemplary in nature andin number and should not be construed as limiting. Any number ofcomponents/modules may be employed to achieve the desired functionalitywithin the scope of embodiments hereof. Further, the services 210, 212,and 214 may be located on any number of servers. By way of example only,the dynamic association and documentation service 210 might reside on aserver, a cluster of servers, or a computing device remote from one ormore of the remaining services.

It should be understood that this and other arrangements describedherein are set forth only as examples. Other arrangements and elements(e.g., machines, interfaces, functions, orders, and groupings offunctions, etc.) can be used in addition to or instead of those shown,and some elements may be omitted altogether. Further, many of theelements described herein are functional entities that may beimplemented as discrete or distributed components or in conjunction withother components/modules, and in any suitable combination and location.Various functions described herein as being performed by one or moreentities may be carried out by hardware, firmware, and/or software. Forinstance, various functions may be carried out by a processor executinginstructions stored in memory.

The data store 216 is configured to store information for use by, forexample, the services 210, 212, and 214 and the end-user computingdevice 218. The information stored in association with the data store216 is configured to be searchable for one or more items of informationstored in association therewith. The information stored in associationwith the data store 216 may comprise general information used by theservices 210, 212, and 214 and/or the end-user computing device 218.

In one aspect, the data store 216 stores electronic medical records(EMRs) of patients associated with a healthcare facility. EMRs maycomprise electronic clinical documents such as images, clinical notes,orders, summaries, reports, analyses, or other types of electronicmedical documentation relevant to a particular patient's conditionand/or treatment. Electronic clinical documents contain various types ofinformation relevant to the condition and/or treatment of a particularpatient and can include information relating to, for example, patientidentification information, images, alert history, culture results,physical examinations, vital signs, past medical histories, surgicalhistories, family histories, histories of present illnesses, current andpast medications, allergies, symptoms, past orders, completed orders,pending orders, tasks, lab results, other test results, patientencounters and/or visits, immunizations, physician comments, nursecomments, other caretaker comments, and a host of other relevantclinical information.

Additionally, the data store 216 may store information concerningdecision-support algorithms, differential or possible diagnosesalgorithms, reference materials, standards of care, recommendationprotocols, alert protocols, and the like. This information may bespecific to a healthcare facility, or the information may be promulgatedby, for example, nationally-recognized medical organizations orgoverning bodies. The data store 216 may also store informationconcerning staffing assignments and/or clinicians and care teamsassigned to care for a patient as well as general information concerningthe clinicians (e.g., office hours, office location, contactinformation, and the like).

The content and volume of such information in the data store 216 are notintended to limit the scope of embodiments of the present invention inany way. Further, though illustrated as a single, independent component,the data store 216 may, in fact, be a plurality of storage devices, forinstance, a database cluster, portions of which may reside on theservices 210, 212, and 214, the end-user computing device 218, and/orany combination thereof.

As shown, the end-user computing device 218 includes the display screen219. The display screen 219 is configured to display information to theuser of the end-user computing device 218, for instance, informationrelevant to communications initiated by and/or received by the end-usercomputing device 218, graphical user interfaces for dynamically creatingassociations and taking actions with respect to an item of clinicalinformation, graphical user interfaces for facilitating patient care bya multi-disciplinary care team, graphical user interfaces for searchingclinical documents, and/or the like. Embodiments are not intended to belimited to visual display but rather may also include audiopresentation, combined audio/visual presentation, and the like. Theend-user computing device 218 may be any type of display device suitablefor presenting a graphical user interface. Such computing devices mayinclude, without limitation, a computer, such as, for example, any ofthe remote computers 108 described above with reference to FIG. 1. Othertypes of display devices may include tablet PCs, PDAs, mobile phones,smart phones, as well as conventional display devices such astelevisions. Interaction with the display screen 219 of the end-usercomputing device 218 may be through conventional methods such as a mouseor a touch pad; interaction with the display screen 219 may also occurthrough the use of gestures such as tapping, swiping, flicking,pinching, and the like.

The computing system environment 200 is merely exemplary. While theservices 210, 212, and 214 are illustrated as single units, it will beappreciated that the services 210, 212, and 214 are scalable. Forexample, each service may in actuality include a plurality of computingdevices in communication with one another. Moreover, the data store 216,or portions thereof, may be included within, for instance, the services210, 212, and 214 as a computer-storage medium. The single unitdepictions are meant for clarity, not to limit the scope of embodimentsin any form.

Dynamic Association and Documentation

The dynamic association and documentation service 210 facilitates thepresentation of a GUI that enables clinicians to address a clinicalfinding at the point it is encountered in a workflow. A clinical findingmay encompass an item of clinical information such as a lab result, aprocedure result, a clinical note, a clinical report, a radiograph, anEKG, an EEG, and the like. The GUI allows the clinician to associate theclinical finding with existing patient diagnoses and/or possiblediagnoses related to the clinical finding. As well, the GUI enables theclinician to review historical information related to the finding andtake actions with respect to the clinical finding. All this isaccomplished without requiring the user to navigate away from thecurrent workflow. Instead, the clinical finding is selected on thecurrent workflow, and the GUI is presented as an overlay on the existingcontent of the workflow.

As shown in FIG. 2, the dynamic association and documentation service210 comprises a rendering component 222, an association component 224,and an action component 226. In some embodiments, one or more of thecomponents 222, 224, and 226 may be implemented as stand-aloneapplications. In other embodiments, one or more of the components 222,224, and 226 may be integrated directly into the operating system of acomputing device such as the remote computer 108 of FIG. 1. It will beunderstood that the components 222, 224, and 226 illustrated in FIG. 2are exemplary in nature and in number and should not be construed aslimiting. Any number of components may be employed to achieve thedesired functionality within the scope of embodiments hereof.

The rendering component 222 of the dynamic association and documentationservice 210 is configured to render a GUI upon a user selecting aclinical finding in a clinical workflow application. The GUI ispresented such that it overlays existing content associated with theclinical workflow application. As used throughout this application, theterm “clinical workflow application” or its equivalents encompasses avariety of clinical workflow applications. Such applications arenumerous but may include an ordering workflow, a documentation workflow,a patient review workflow, a patient list workflow, and the like.

The rendering component 222 is configured to use the data stored inassociation with the data store 216 (e.g., electronic medical recordinformation, reference materials, differential or possible diagnosesalgorithms, and the like) to present information on the GUI. Theinformation rendered by the rendering component 222 may include trendinginformation related to the selected clinical finding. The trendinginformation includes a historic overview of values or other attributesassociated with the clinical finding and may be presented in associationwith a timeline. The timeline may further include one or more iconsrepresenting clinical documents and/or orders that reference or relateto the selected clinical finding. The icons, which are actionable,overlay the timeline at points in time corresponding to when theclinical document and/or order was created. A user can interact with anicon by selecting the icon, hovering over the icon, or executing agesture with respect to the icon (e.g., tapping, swiping, etc.) toinitiate a presentation of the clinical document and/or order associatedwith the icon. The information rendered by the rendering component 222may also include labs and/or medications that are related to theclinical finding. The labs and/or medications may be deemed to berelated based on explicit clinician linkages, reference materials, orbased on an analysis of the statistical occurrence of the labs andmedications with the selected item of clinical information.

The information presented by the rendering component 222 may alsoinclude a current problem list for the patient. The current problem listincludes one or more problems that have previously been declared to beassociated with the patient either automatically, and without humanintervention, based on one or more rules or based on a clinician makingthe association. The rendering component 222 may also present one ormore possible diagnoses related to the clinical finding. The possiblediagnoses may be generated based on differential diagnoses algorithmsstored in association with the data store 216. For example, a clinicalfinding of low potassium may be associated with possible diagnoses suchas hypokalemia, hyperaldosteronism, diuretics, laxative abuse, anddiarrhea. Each of the current problems and the possible diagnoses isselectable by a user. Selection causes the clinical finding to beelectronically associated with the selected current problem and/orpossible diagnosis in the patient's electronic medical record. This willbe explored in greater depth below with respect to the associationcomponent 224.

Continuing, the rendering component 222 is further configured to presentan action display area that includes one or more selectable actions thatenable a user to initiate actions with respect to the clinical finding.The actions may include placing an order with respect to the clinicalfinding, associating the clinical finding with one or more documentssuch as a clinical note, communicating a message to another caregiver,the patient, or a member of the patient's family regarding the clinicalfinding, and/or reviewing a synopsis of the patient's medical history ora history of the clinical finding such as previous actions,documentation, comments, or orders taken with respect to the selectedclinical finding.

The association component 224 of the dynamic association anddocumentation service 210 is configured to associate the selectedclinical finding with one or more of a current declared patient problem,a possible diagnosis related to the clinical finding, and/or a new orexisting clinical document. The declared association is stored inassociation with the patient's electronic medical record where it can beaccessed by other clinician workflow applications. The association maybe triggered in response to a user selecting a current problem or apossible diagnosis on the GUI, or by selecting an action that enablesthe user to associate the item of clinical information with, forexample, a document such as a clinical note, a radiology report, aprocedure report, and the like.

The action component 226 of the dynamic association and documentationservice 210 is configured to present information associated with one ormore actions and to initiate one or more actions selected by a user. Asmentioned above, the rendering component 222 is configured to render anaction display area with one or more selectable actions. Upon a userselection of an action, the action component 226 is configured topresent information associated with the selected action. For instance,user selection of an ordering action initiates the display of, forexample, an order profile for the patient, treatment guidelines for anycurrent problems or possible diagnoses selected by the user, andsuggested orders and/or order sets related to the current problemsand/or possible diagnoses selected by the user. If the user selects asuggested order, the action component 226 is configured to initiate theorder and store the order in association with the patient's electronicmedical record.

Selection of a document action causes the action component 226 topresent, for example, a clinical document GUI similar to that shown inFIGS. 6 and 6A that enables the user to search for an existing clinicaldocument and electronically associate the selected clinical finding withthe existing clinical document. In addition to, or in the alternative,the clinician can create a new clinical document using the clinicaldocument GUI and associate the clinical finding with the new clinicaldocument. Additionally, the clinical document GUI also presents one ormore clinically-relevant documentation aids based on the associatedclinical finding or based on previous documented actions. The clinicaldocument GUI will be explained in greater depth below.

Selection of a message action causes the action component 226 to presentmessaging options (e.g., instant messaging, e-mail, calling, and/orpaging options), including the use of predefined messaging templates,and to facilitate the communication of any created messages. Selectionof a history action causes the action component 226 to present asynopsis of the patient's medical history, previous clinical actions,comments, documentation, messages, and/or a review of the selectedclinical finding.

Turning to FIG. 3, FIG. 3 depicts an exemplary GUI 300 that is currentlyutilized by clinicians in their practice. The GUI 300 is an example of aclinical workflow application in which a clinician can review varioustypes of information associated with a patient. In this case, aclinician 305 who is accessing the GUI 300 is identified (also known asthe viewer 305), and a patient 310 who is the subject of the GUI 300 isalso identified. Currently, the viewer 305 is reviewing labs 312associated with the patient. The viewer 305 notices that the potassiumvalue has been flagged as elevated, and, as shown by the numeral 314,the viewer 305 selects the abnormal potassium value. Although a labvalue is shown as selected by the viewer 305, it is contemplated thatthe viewer 305 can select other clinical findings such as a medication,a report, clinical or health concepts within a clinical document, adevice reading, a vital sign, and the like. Any and all such aspects,and any combination thereof, are contemplated as being within the scopeof the invention.

FIG. 4 depicts an exemplary GUI 410 that is initiated upon the viewer305 selecting, for example, the abnormal potassium value on the GUI 300(the abnormal potassium value is now known as the clinical finding 412).The GUI 410 may also be initiated upon the viewer 305 selecting amedication, a clinical document, a health concept, a device reading, avital sign, and the like. Although the GUI 410 is shown as beinginitiated upon selection of a lab value on the GUI 300, it iscontemplated that the GUI 410 may be initiated from any clinicianworkflow application.

As seen, the GUI 410 overlays a portion of the content associated withthe GUI 300. The GUI 410 includes several different display areas—arelated information display area 405, an association display area 426,and an action display area 436. The related information display area 405includes identifying information associated with the selected clinicalfinding 412 (e.g., a name and any current values associated with theclinical finding 412). The related information display area 405 alsoincludes trending information 414 for the clinical finding 412. Thetrending information 414 may be presented in a graphical form withindications of when the clinical finding 412 was tested and any valuesassociated with the tests; a user can hover over the indications and bepresented with this information.

The related information display area 405 may also include an interactivetimeline 416 having bounds corresponding to when the clinical finding412 was first tested, created, ordered, measured, etc. and a currenttime. Actionable icons, such as icons 418 and 420, may overlay thetimeline 416 and represent orders and/or documents that reference orrelate to the clinical finding 412. The icons 418 and 420 overlay thetimeline 416 at points in time corresponding to when the order and/ordocument was created. For example, the icon 418 may represent a set oforders that relate to or reference the clinical finding 412; it overlaysthe timeline 416 at a point in time corresponding to when the set oforders was created. Likewise, the icon 420 represents a clinicaldocument that relates to and/or references the clinical finding 412; italso overlays the timeline 416 at a point in time corresponding to whenthe clinic document was created. Interaction with the icons 418 and/or420 initiates a summary view of the orders and/or documents representedby the icons 418 and/or 420.

The related information display area 405 further includes a related labsarea 422 that includes one or more lab values that have been determinedto be related to the clinical finding 412. Additionally, a relatedmedications area 424 is also shown that includes one or more medicationsthat have been determined to be related to the clinical finding 412. Thedetermination that the lab values and/or medications are related to theclinical finding 412 may be made based upon reference materials,explicit clinician linkages, and/or a statistical analysis of theco-occurrence of the clinical finding 412 with the lab value and/ormedication.

The association display area 426 presents a list of one or moreselectable current problems 428 associated with the patient, a list ofone or more selectable possible diagnoses 430 related to the clinicalfinding 412, a search area 432, and an input area 431. The currentproblems 428 include those problems that have been previously identifiedto be associated with the patient. The possible diagnoses 430 relate tothe clinical finding 412 and may be generated using differentialdiagnoses algorithms and/or reference materials stored in associationwith a data store such as the data store 216 of FIG. 2. When theclinical finding 412 is, for example, an abnormal lab value, thepossible diagnoses 430 may include one or more medical conditions thatmay cause or be associated with the abnormal lab value. When theclinical finding 412 is, for example, a medication, the possiblediagnoses may include medical conditions for which the medication iscommonly taken and/or conditions caused by taking the medication. If theclinical finding 412 is, for example, a report or clinical document thatreferences a medical condition, the possible diagnoses 430 may includeadditional medical conditions commonly associated with the referencedmedical condition. The search area 432 enables a user to search foradditional diagnoses not already associated with the patient orpresented to the viewer. If an additional diagnosis is discovered usingthe search area 432, the additional diagnosis can be associated with theclinical finding 412. The input area 431 shows the list of associateddiagnoses and enables the user to input any comments related to acreated association.

As mentioned, each of the current problems 428 and each of the possiblediagnoses 430 are selectable. Selection of one or more of these items,such as hypokalemia 434, creates an association in the patient's EMRbetween the selected item and the clinical finding 412. Thus, in thecase of hypokalemia, an association in the patient's EMR would be madebetween the low potassium and the diagnosis of hypokalemia. Createdassociations are subsequently available to workflow applicationsaccessing the patient's EMR. This feature obviates the need for a userto separately open each workflow application and document theassociation.

The action display area 436 includes a number of action tabs—an orderaction tab 438, a document action tab 440, a message action tab 442, anda history action tab 444—that enable a user to take action with respectto the clinical finding 412. Selection of one of the action tabs 438,440, 442, or 444 initiates the presentation of information associatedwith the respective action. For example, as shown, selection of theorder tab 438 initiates the presentation of an order profile 446detailing any current orders associated with the patient, treatmentguidelines 448 related to the selected current problem 428, possiblediagnosis 430, or the clinical finding 412, and suggested order sets 450for treatment of the selected current problem 428, possible diagnosis430, or the clinical finding 412.

Additional information presented upon selection of the order tab 438includes an annotation area 452 where the clinician can inputannotations related to any new orders, as well as options for selectingsuggested orders 454, favorite orders 456, and current orders 458. Thesuggested orders 454 can relate to the selected current problem 428 orpossible diagnosis 430 and can include suggested order sets. Favoriteorders 456 are customized based on the clinician who is accessing theGUI 410, and current orders 458 detail all current orders associatedwith the patient.

Selection of the document action tab 440 enables the user to associate aselected current problem 428 or possible diagnosis 430, and/or theclinical finding 412 with one or more of an existing clinical documentsuch as a clinical note or a report, or with a new clinical document.Furthermore, selection of the document action tab 440 presents suggestedclinical document templates, questionnaires, and/or other documentationaids. In one aspect, selection of the document tab 440 initiates thepresentation of a GUI similar to that shown in FIG. 6. The GUI of FIG. 6enables a clinician to quickly search through existing documents orcreate a new clinical document; this will be explained in greater depthbelow.

Selection of the message tab 442 initiates the presentation of one ormore message options including instant message options, calling options,paging options, and e-mail options. The message options may include oneor more predefined e-mail templates. Selection of the history tab 444initiates the presentation of one or more of a synopsis of the patient'smedical history, previous associated actions, and/or an overview of theinformation presented in the related information display area 405.

As seen, the dynamic association and documentation service 210 and itsassociated GUI 410 enable a clinician to address a clinical finding atthe time it is discovered. The clinician can view clinical informationrelated to the clinical finding, associate the clinical finding with acurrent problem, a clinical document, or a possible diagnosis, and/ortake one or more actions related to the clinical finding. The cliniciancan fully address the clinical finding without having to navigate tomultiple separate workflow applications.

Multi-Disciplinary Team Workspace

The multi-disciplinary care team service 212 facilitates the generationof a GUI that enables different care teams caring for a patient to,among other things, review actions taken by each of the care teams,review clinical information related to a patient problem, and initiateone or more actions with respect to a patient problem.

The multi-disciplinary care team service 212 comprises a renderingcomponent 230, a care team component 232, an action component 234, and aclinical information component 236. In some embodiments, one or more ofthe components 230, 232, 234, and 236 may be implemented as stand-aloneapplications. In other embodiments, one or more of the components 230,232, 234, and 236 may be integrated directly into the operating systemof a computing device such as the remote computer 108 of FIG. 1. It willbe understood that the components 230, 232, 234, and 236 illustrated inFIG. 2 are exemplary in nature and in number and should not be construedas limiting. Any number of components may be employed to achieve thedesired functionality within the scope of embodiments hereof.

The rendering component 230 of the multi-disciplinary care team service212 is configured to use the data stored in association with the datastore 216 (e.g., electronic medical record information, referencematerials, alerting protocols, differential diagnoses algorithms,staffing information, clinician assignments, etc.) to presentinformation on a multi-disciplinary care team workspace GUI. Theinformation presented by the rendering component 230 is customized basedon the identity of the user accessing the GUI. The rendered informationincludes one or more declared clinical problems associated with apatient. The declared clinical problems may include possible diagnosesthat were associated with an item of clinical information using, forexample, the GUI 410 of FIG. 4. For each identified clinical problem,the rendering component 230 is configured to present alert informationcomprising one or more items that need to be addressed by the user,recommendations for treating the identified clinical problem, actionicons representing actions that can be taken with respect to theclinical problem, care team icons representing care teams responsiblefor treating the clinical problem, clinical information iconsrepresenting clinical information associated with the identifiedproblem, and any annotations related to the identified clinical problem.The annotations may comprise annotations created using the GUI 410 ofFIG. 4.

Selection of an action icon causes the action component 234 to presentinformation associated with the icon and to initiate one or moreactions. The actions that can be taken with respect to the clinicalproblem may include review actions where the user can review clinicaldocumentation related to the clinical problem, order actions where theuser can place an order with respect to the clinical problem, documentactions where the user can create a clinical document addressing theclinical problem, and communication actions where the user can initiateone or more communications (e.g., instant messaging, paging, e-mail,and/or calling) with respect to the clinical problem.

Care team icons represent care teams responsible for treating a givenclinical problem. An individual clinical problem may be associated withmore than one care team. For example, a patient suffering from atrialfibrillation may be cared for by an internal medicine care team and acardiovascular care team. Selection of a care team icon causes the careteam component 232 to present information associated with the selectedcare team icon. This information may include the identity of a clinicianon the care team who is assigned to care for the patient as well asoffice hours for that clinician. Additional information includes recentorders created by the clinician for the clinical problem, recentdocuments created by the clinician that address the clinical problem,information on when the clinician last rounded on the patient, andoptions for contacting the clinician including instant messagingoptions, e-mail options, paging options, and calling options.

Clinical information icons represent various types of clinicalinformation associated with a clinical problem. Exemplary types ofclinical information includes currently prescribed medications beingused to treat the clinical problem, existing clinical documents thatrelate to or reference the clinical problem, laboratories related to theclinical problem, radiology images and/or reports related to theclinical problem, surgery reports associated with the clinical problem,and any messages that reference the clinical problem. Selection of oneof the clinical information icons causes the clinical informationcomponent 236 to present the information associated with the icon.

The clinical information icons may be rendered by the renderingcomponent 230 in a variety of states. For example, a clinicalinformation icon may be presented in tagged state indicating thatinformation associated with the icon has been tagged by anotherclinician for review by the viewer of the GUI. A review state indicatesthat clinical information associated with the icon has not beenpreviously reviewed by the viewer of the GUI. A previously-viewed stateindicates that the clinical information associated with the icon hasbeen previously viewed by the viewer of the GUI, and a no-informationstate indicates that there is currently no clinical informationassociated with the icon.

The rendering component 230 is further configured to present one or moreselectable identified clinical findings associated with the patient. Theclinical findings are identified by accessing the patient's EMR andidentifying pertinent clinical findings. Upon selection of one or moreof the identified clinical findings, the rendering component 230 mayutilize differential diagnoses algorithms stored in a data store, suchas the data store 216 of FIG. 2, to present one or more selectablepossible diagnoses related to the selected findings. Further, some ofthese possible diagnoses may be flagged as high risk. Additionally, uponselection of one of the possible diagnoses, a summary may be initiatedthat explains why the multi-disciplinary care team service 212 generatedthat particular diagnosis.

FIG. 5 depicts an exemplary GUI 500 generated by the multi-disciplinarycare team service 212. The GUI 500 includes an area that identifies aclinician or viewer 505 accessing the GUI 500 and an area thatidentifies the patient 510. As mentioned above, the informationpresented on the GUI 500 is customized based on the identity of theviewer 505. The GUI 500 may be initiated upon the viewer 505 selecting atab 512 (e.g., “Prodigy Viewer”). The GUI 500 includes a declaredclinical problem display area 514 that displays one or more clinicalproblems associated with the patient. Some of these clinical problemsmay have been declared using the GUI 410 of FIG. 4. Each patient problemin the clinical problem display area 514 may be associated with alerts,recommendations, action icons, care team icons, clinical informationicons, and annotations.

For example, alert display area 516 presents visual indicators used toalert the viewer 505 to one or more items that need to be addressed fora particular patient problem. The visual indicators may be shadeddifferent colors to indicate the existence or absence of an alertrelated to one of the clinical problems in the clinical problem displayarea 514. A recommendation display area 518 presents indicatorsindicating whether recommendations exist for a particular patientproblem. The user can select the indicator and be presented with a listof recommendations related to the clinical problem.

An action display area 519 includes one or more action icons such asreview icons 520, order icons 522, document icons 524, and communicationicons 526 related to a clinical problem. Selection of the review icon520 for a clinical problem initiates the presentation of one or moreclinical documents that reference or relate to the clinical problem.Alternatively, selection of the review icon 520 may initiate a summaryof information related to the declared clinical problem. Selection ofthe order icon 522 for a clinical problem initiates an ordering screenwhere the user can create an order related to the patient problem.Selection of a document icon 524 for a clinical problem initiates a userinterface where the user can create a clinical document such as aclinical note related to the clinical problem. In one aspect, the userinterface initiated upon selection of the document icon 514 may besimilar to the GUI shown in FIG. 6. Selection of a communication icon526 for a clinical problem initiates one or more options (e.g., instantmessaging, paging, e-mail, calling) for communicating with anothercaregiver on the patient's care team.

A care team display area 528 is configured to present one or more careteam icons where each icon gives an indication of the care team(s)currently assigned to care for a particular patient problem. Forinstance, care team icons 525 and 527 indicate that an internal medicinecare team and a cardiovascular care team have been assigned to care forthe patient problem “Atrial Fibrillation” 529. Each of the care teamicons in the care team display area 528 is actionable. Interaction witha care team icon such as care team icon 549 initiates the presentationof care team information 550. The care team information 550 includes anidentity of a clinician 552 on the care team who is currently assignedto care for the patient. The care team information 550 also includesoffice hours 554 for the clinician 552. Additionally, the care teaminformation 550 includes rounding icon 556, order icon 558, clinicaldocument icon 560, and communication icons 562. Interaction with therounding icon 556 provides information on when the clinician 552 lastrounded on the patient. Interaction with the order icon 558 presentsinformation on orders entered by the clinician 552 for the particularclinical problem, and interaction with the clinical document icon 560presents information on clinical documents created by the clinician 552for the patient problem. Selection of one of the communication icons 562enables the viewer 505 to initiate one or more communication paths withthe clinician 552.

Clinical information review icons 529 include actionable medicationreview icons 530, note review icons 531, lab review icons 532, radiologyreview icons 534, surgery review icons 536, and message review icons538. Each of the icons 530, 531, 532, 534, 536, and 538 may be presentedin one of several states. A tagged state is shown by note review icon542 and indicates that information associated with the note review icon542 has been tagged by another clinician for review by the viewer 505.Additionally, the tagged state may be created based on the informationassociated with the note review icon 542 meeting predefined criteria.For example, the information may comprise a lab value that is outsidethe normal range, and this may trigger the icon 542 to be presented in atagged state. The tagged state may be shown as a solid outline of theicon 542 along with a number indicating the number of items that need tobe reviewed. A review state is shown by note review icon 544 andindicates that clinical information associated with the note review icon544 has not been previously reviewed by the viewer 505. A review statemay be shown as a solid outline of the icon 544. A previously-viewedstate is shown by note review icon 546 and indicates that clinicalinformation associated with the note review icon 546 has been previouslyviewed by the viewer 505. A previously-viewed state may be shown bygraying out the outline of the icon 546. A no-information state is shownby an absence of an icon (as shown by numeral 548) and indicates thatthere is no clinical information available. Other ways of indicating anicon state are contemplated as being within the scope of the inventionand include such ways as color-coding, altering the shape of the icon,and the like.

The medication review icons 530 provide information concerningmedications that are currently prescribed for a particular clinicalproblem, and note review icons 531 provide information concerningclinical documents that relate to and/or reference the particularpatient problem. The lab review icons 532 present information aboutlaboratory values/readings related to the particular patient problem,and the radiology review icons 534 present radiology reports and/orimages related to the patient problem. The surgery review icons 536present information such as procedure or surgery reports that arerelated to the particular patient problem, and the message review icons538 present messages from, for example, other members of the patient'scare teams that relate to the particular patient problem.

The GUI 500 further comprises an annotation display area 540 thatpresents any annotations that have been documented for a particularclinical problem including those annotations documented using the GUI410 of FIG. 4. An identified findings display area 564 presentsselectable clinical findings that have been identified for the patient.The clinical findings may have been identified by accessing thepatient's EMR and analyzing the information contained therein toidentify clinical findings of significance. The viewer 505 of the GUI500 can select one or more of the findings and be presented withpossible diagnoses 568 that relate to the selected finding(s). Further,at least a portion of the possible diagnoses 568 may be flagged as highrisk 570 to further draw the viewer's attention to possible problems.The generation of the possible diagnoses 568 and the high risk diagnoses570 may be based on differential diagnoses algorithms stored inassociation with a data store such as the data store 216 of FIG. 2. Theviewer 505 can select one of the possible diagnoses 568 to initiate asummary that explains why the possible diagnosis 568 was selected inrelation to the selected identified findings 564.

By way of illustrative example, a patient's EMR may be accessed andclinical findings of night sweats and atypical pneumonia may beidentified. The clinical findings are presented in the identifiedfindings display area 564. The viewer 505 can select both of theseclinical findings and be presented with possible diagnoses 568 of AIDSand lymphoma. Further, the diagnosis of AIDS may be flagged as high riskto draw the viewer's attention. The viewer 505 can select the AIDSdiagnosis and be presented with information on how the AIDS diagnosisrelates to the selected clinical findings.

The multi-disciplinary care team service 212 and its associated GUI 500assist care teams in their management of patients with multiple medicalproblems. A member of the care team can access the GUI 500 and quicklyreview each care team's contributions to the patient's care as well aspatient clinical information. Additionally, the GUI 500 enables the careteam member to take actions with respect to a particular patient problemand to review identified clinical findings for the patient.

Clinical Document Speed Viewer

The clinical document service 214 of FIG. 2 is configured to generate aGUI that enables a clinician to quickly search through all the clinicaldocuments, such as daily notes and/or reports, associated with apatient. Preferences can be set that define which types of clinicaldocuments to be considered, thus allowing a clinician to excludeclinical documents that may not be relevant to the current reviewprocess. For example, an ambulatory doctor may choose to excludeinpatient nurse assessment notes. Additionally, the clinician can setpreferences specifying authors of clinical documents to be searched. Theclinician can further filter the documents based on criteria such ashealth concepts that have been identified for the patient. Selecteddocuments that meet filter and preference criteria can be quicklysearched by restricting the document to specified document sections andonly presenting information that has not previously been reviewed by theuser of the GUI.

The clinical document service 214 comprises a rendering component 238, afilter and preference component 240, a retrieval component 242, and aclinical document component 244. In some embodiments, one or more of thecomponents 238, 240, 242, and 244 may be implemented as stand-aloneapplications. In other embodiments, one or more of the components 238,240, 242, and 244 may be integrated directly into the operating systemof a computing device such as the remote computer 108 of FIG. 1. It willbe understood that the components 238, 240, 242, and 244 illustrated inFIG. 2 are exemplary in nature and in number and should not be construedas limiting. Any number of components may be employed to achieve thedesired functionality within the scope of embodiments hereof.

The rendering component 238 of the clinical document service 214 isconfigured to use the data stored in association with the data store 216(e.g., electronic medical record information) to present information ona clinical document workspace GUI. The information presented by therendering component 238 includes a searchable timeline having boundscorresponding to when a clinical document was first documented for apatient to the current point in time. The searchable timeline includes aplurality of actionable icons representing clinical documents associatedwith the patient. The icons are overlaid on the timeline at points intime corresponding to when the icon's respective clinical document wascreated. The icons are variably shaded or colored to indicate theapplication of one or more filters and/or preferences. For instance,icons representing documents that meet user preferences may be shaded adark grey or black, while icons representing documents that do not meetuser preferences may be shaded a light grey. Further, icons representingdocuments that meet filter criteria may be shaded a color such as green.These examples of shading and colors are meant to be exemplary only, anyway of shading or coloring the icons to indicate satisfaction ofpreference or filter criteria is contemplated as being within the scopeof the invention. Further, the icons may be variably sized to indicatethe number of clinical documents associated with a particular icon.

Interaction with an icon by, for example, hovering over the icon, mayinitiate the presentation of a date and time when the respectivedocument was created. Alternatively, or in addition to, interaction withthe icon may initiate a thumbnail view of the respective document.Selection of an icon on the searchable timeline by, for example,clicking on the icon or using a tapping or swiping gesture, causes theretrieval component 242 to retrieve the respective clinical documentfrom the patient's EMR; the retrieved document is subsequently presentedto the viewer of the GUI.

The rendering component 238 is further configured to present one or moreselectable document section options on the GUI. Exemplary documentsection options may include chief complaint, documents, vital signs,labs, home medications, diagnostics, procedure history, consolidatedproblems, subjective or history of present illness, review of systems,new order entry, objective or physical exam, health maintenance, patienteducation or follow-up, and/or assessment and plan. A viewer of the GUIcan select one or more document section options and restrict a displayeddocument to the selected section(s). The document sections may have beenidentified in the displayed document using natural language processing.

The rendering component 238 is additionally configured to present one ormore preference options and one or more filter options to a viewer ofthe GUI. Selection of a preference and/or filter option causes thefilter and preference component 240 to restrict the patient's clinicaldocuments to those that meet the preference and filter criteria. Asexplained above, this may be shown visually by variably shading and/orcoloring the icons representing the clinical documents on the searchabletimeline. Preference options may include options to restrict clinicaldocuments based on author or role type (e.g., clinical documentsauthored by a physician versus clinical documents authored by a physicaltherapist or patient), and/or options to restrict clinical documentsbased on the type of document (e.g., daily note versus radiologyreport). Further, preference options may include options to restrictclinical documents based on timeframe or numeric count (e.g., clinicaldocuments generated in the last six month or the most-recent 100clinical documents), and options to restrict based on encounter type orvenue (e.g., clinical documents generated during ambulatory visitsversus clinical documents generated during inpatient stays). Additionalpreference options include options to restrict clinical documents basedon clinical service (e.g., hospitalist team versus surgical team) orprovider type (e.g., specialist versus level of training such as amedical student or resident).

Filter options are based on health concepts associated with the patient.Health concepts associated with the patient may include declareddiagnoses associated with the patient, medications associated with thepatient, and tests and procedures associated with the patient. Healthconcepts may be associated with the patient based on a clinician makingan explicit association between a clinical finding and a possiblediagnosis using the GUI 410 depicted in FIG. 4.

The rendering component 238 may additionally present the health conceptsassociated with the patient as a separate side bar on the GUI. Thehealth concepts may be categorized under category headings such asdiagnosis, medications, tests, and procedures. A viewer of the GUI canselect a health concept to access reports or other documentation thatrelate to or reference the selected health concept. Alternatively, or inaddition to, the viewer can select a health concept and initiate thepresentation of an association GUI as exemplified by the GUI 410 of FIG.4. Utilizing this GUI, the viewer can associate the health concept witha declared diagnosis, a possible diagnosis, a clinical document, and thelike as explained above in relation to the GUI 410 of FIG. 4.

Once a clinical document has been selected and presented on the GUI bythe rendering component 238, the clinical document component 244utilizes the health concepts associated with the patient to highlightkey terms in the presented document. Highlighting may be through boldingthe key terms or shading the key terms a different color than the restof the document contents. The clinical document component 244 is furtherconfigured to grey out those portions of the presented document thathave previously been viewed by the viewer of the GUI thereby enablingthe viewer to target previously unviewed text. The highlighted key termsare selectable. Upon selection of a key term, a GUI similar to the GUI410 of FIG. 4 is initiated enabling the viewer to associate the selectedterm with a declared patient problem, a possible diagnosis related tothe selected key term, a clinical document, and the like.

Turning now to FIG. 6, FIG. 6 depicts an exemplary clinical documentspeed viewer 600 illustrating aspects discussed above. The GUI 600includes an area identifying a viewer 605 of the GUI 600. Additionally,the GUI 600 includes an area identifying the patient 610. The GUI 600includes several different display areas include a note section displayarea 612, a clinical document display area 614, a preference selectionarea 620, a filter selection area 622, a searchable timeline displayarea 616, and a health concepts display area 624. The note sectiondisplay area 612 is configured to present one or more document sectionoptions. Selection of a document section option restricts any displayedclinical document to the selected section(s).

The clinical document display area 614 is configured to enable theviewer 605 to generate a new clinical document. As well, the clinicaldocument display area 614 is configured to present an existing clinicaldocument selected by the viewer 605. Those portions of the clinicaldocument corresponding to selected note sections are presented. If theviewer 605 does not restrict the document to one or more specified notesections using the note section options presented in the note sectiondisplay area 612, then the entire clinical document will be presented.

The clinical note display area 614 includes a “changes or differencesonly” option 634 and an “entire section” option 636. Selection of the“changes or differences only” option 634 restricts the presentedinformation to content that has not previously been reviewed by theviewer 605. Content that has previously been viewed may be grayed out orhidden from view. This is true even if the content was reviewed by theviewer in another clinical document by the same author, in anotherclinical document by a different author, or in another section of thecurrent clinical document. Selection of the entire section option 636causes all of the content of the presented clinical document to be shownregardless of whether portions of the content have been previouslyviewed. As mentioned earlier, key terms in the presented document thatare associated with identified patient health concepts may behighlighted—this is shown by the numerals 638 and 640. Highlighting maybe through bolding, underlining, shading or coloring, and the like.

The searchable timeline 616 is presented as a vertical timeline adjacentto the clinical document display area 614. Although shown as a verticaltimeline, it is contemplated that the searchable timeline 616 may bepresented in different configurations such as a horizontal timeline. Thesearchable timeline 616 has a time span encompassing the lifetime recordof the patient's clinical documents (e.g., 2011 to 2013 as shown in FIG.6). The searchable timeline 616 includes a plurality of interactiveicons representing clinical documents. Interaction with an icon, such ashovering over an icon, initiates the presentation of a date and timewhen the document was created. This is shown by the numeral 618.Hovering over an icon may additionally initiate the presentation of athumbnail image of the document represented by the icon. Selection of anicon initiates the presentation of the clinical document associated withthe icon in the clinical document display area 614.

The preference selection area 620 includes options for the viewer 605 toset one or more preferences as outlined above. Preferences may be basedon author of the clinical document, type of document, timeframe, numericcount, encounter type, venue, clinical service, provider type, and thelike. The filter selection area 622 presents filters that havepreviously been selected by the viewer 605. In this case, the viewer hasselected to filter the clinical documents by two of the patient'sdiagnoses—stable angina and atrial fibrillation. Those documents thatrelate to or reference these diagnoses will be highlighted on thesearchable timeline 616 by, for example, coloring the icons representingthe desired documents differently from the other icons.

FIG. 6A depicts the presentation of filter options. As described above,the filter options correspond to health concepts that have beenidentified for the patient 610. FIG. 6A includes selected filters 710which correspond to the selected filters 622 of FIG. 6. FIG. 6A furtherincludes one or more additional filter options that are categorized bydiagnosis 716, medications 718, tests 720, and procedures 722. Each ofthe filter options is selectable and can be selected to further filterthe patient's clinical documents. FIG. 6A further includes a search box714 by which the viewer 605 can search for health concepts associatedwith the patient.

Returning to FIG. 6, the GUI 600 further includes the health conceptsdisplay area 624. The health concepts display area 624 presents healthconcepts that have been identified for the patient 610 either based onthe patient's electronic medical record or based on a currentlydisplayed clinical document. The health concepts are categorized basedon, for example, diagnosis 626, medications 628, tests 630, andprocedures 632. Interaction with one of the health concepts in thehealth concepts display area 624 may initiate the presentation ofclinical documents that relate to or reference the selected healthconcepts. Additionally, interaction with one of the health concepts mayinitiate a GUI similar to the GUI 410 of FIG. 4 that enables the viewer605 to associate the selected health concept with one or more declaredpatient problems, possible diagnoses related to the selected healthconcept, a clinical document, and the like.

The clinical document service 214 and its associated GUI 600 enable aclinician to quickly search through a patient's clinical documents. Theability to filter clinical documents by identified health concepts,restrict displayed clinical documents by selected document sections, andview previously unviewed content and/or key terms within a selecteddocument further speeds up the search process.

The present invention has been described in relation to particularembodiments, which are intended in all respects to be illustrativerather than restrictive. Further, the present invention is not limitedto these embodiments, but variations and modifications may be madewithout departing from the scope of the present invention.

What is claimed is:
 1. One or more computer-storage media havingcomputer-useable instructions embodied thereon that, when executed by acomputing device, cause the computing device to display a graphical userinterface (GUI) for enabling a user to dynamically create associationsand take actions with respect to a clinical finding associated with apatient, the GUI comprising: an first display area configured to displayboth a current problem list for the patient comprising one or moreselectable declared clinical problems and a possible diagnoses listcomprising one or more selectable possible diagnoses related to theclinical finding, selection of at least one of the one or moreselectable clinical problems or at least one of the one or more possiblediagnoses creating an association between the clinical finding and theselected item in the patient's electronic medical record; and a seconddisplay area configured to display one or more clinical actions,selection of at least one of the one or more clinical actions enabling auser to initiate at least one of the one or more clinical actions withrespect to the clinical finding without navigating away from the GUI. 2.The GUI of claim 1, wherein the GUI is initiated upon selection of theclinical finding presented on a second GUI.
 3. The GUI of claim 2,wherein the GUI overlies content associated with the second GUI.
 4. TheGUI of claim 1, wherein the first display area further comprises atextual input area configured to receive textual input from a userregarding the association between the clinical finding and the selecteditem.
 5. The GUI of claim 1, wherein the one or more clinical actionscomprise at least order actions, document actions, and message actions.6. One or more computer-storage media having computer-useableinstructions embodied thereon that, when executed by a computing device,cause the computing device to display a graphical user interface (GUI)for dynamically creating associations and taking actions with respect toa clinical finding associated with a patient, the GUI comprising: arelated information display area configured to display trendinginformation for the clinical finding; an association display areaconfigured to display both a current problem list for the patient andone or more possible diagnoses related to the clinical finding; and anaction display area configured to display one or more actions related tothe clinical finding.
 7. The GUI of claim 6, wherein the relatedinformation display area further comprises a related labs areaconfigured to display one or more lab values determined to be related tothe clinical finding.
 8. The GUI of claim 7, wherein the relatedinformation display area further comprises a medication display areaconfigured to display one or more medications that are currently beingtaken by the patient, the one or more medications determined to berelated to the clinical finding.
 9. The GUI of claim 8, wherein the oneor more lab values and the one or more medications are determined to berelated to the clinical finding based on reference materials.
 10. TheGUI of claim 8, wherein the one or more lab values and the one or moremedications are determined to be related to the clinical finding basedon explicit clinician preferences.
 11. The GUI of claim 6, wherein thetrending information is presented in association with a timeline. 12.The GUI of claim 11, wherein the timeline includes one or more iconsoverlaid on the timeline at points in time, the one or more iconsrepresenting clinical actions taken at the points in time, the clinicalactions related to the clinical finding.
 13. The GUI of claim 12,wherein the one or more icons are actionable, wherein taking action withrespect to at least one of the one or more icons initiates presentationof information associated with the at least one icon.
 14. The GUI ofclaim 6, wherein the clinical finding comprises at least one of a labvalue, a procedure result, a medication, or a clinical document.
 15. Oneor more computer-storage media having computer-useable instructionsembodied thereon that, when executed by a computing device, cause thecomputing device to display a graphical user interface (GUI) forenabling a user to dynamically create associations and take actions withrespect to a clinical finding associated with a patient, the GUIcomprising: a related information display area configured to display atleast trending information related to the clinical finding and labvalues determined to be related to the clinical finding; an associationdisplay area configured to display at least a current problem listcomprising one or more selectable declared clinical problems for thepatient, a possible diagnoses list comprising one or more selectablepossible diagnoses related to the clinical finding, and one or moreinput areas configured to receive textual inputs, selection of at leastone of the one or more selectable clinical problems or at least one ofthe one or more possible diagnoses creating an association between theclinical finding and the selected item in the patient's electronicmedical record; and an action display area configured to display one ormore clinical action tabs, selection of which enables a user to takeaction with respect to the clinical finding.
 16. The GUI of claim 15,wherein the one or more clinical action tabs comprise an order actiontab, a document action tab, a message action tab, and a history actiontab.
 17. The GUI of claim 16, wherein selection of the order action tabinitiates presentation of an ordering screen comprising one or moresuggested orders related to the clinical finding.
 18. The GUI of claim17, wherein the one or more suggested orders include one or more ordersets related to the clinical finding.
 19. The GUI of claim 16, whereinselection of the document action tab enables a user to associate theclinical finding with one or more existing clinical documents.
 20. TheGUI of claim 16, wherein selection of the message action tab initiatespresentation of a messaging screen that includes one or more predefinedmessaging templates.